Fraud, Waste and Abuse

Combating healthcare fraud, waste and abuse

Healthcare fraud, waste and abuse (FWA) cost the American healthcare system more than $68 billion annually.* No health payer organization can afford to write off this much. Left unchecked, the enormous cost of healthcare fraud, waste and abuse threatens both the quality of healthcare and access to care for millions of Americans.

The STARSSolutions Advantage 

Healthcare is a prime arena for FWA because of the enormous dollar amounts that pass through health payer claims systems. That’s why health plans use edits and audits to protect the integrity of the payments they make. But the fact is, routine claims edits, manual claims auditing and similar functions are not enough to protect you against today’s sophisticated fraud schemes.

With STARSSolutions® Suite, we can help you discern innocent errors from outright fraudulent intent. No other solution in the marketplace provides the same level of detection, automation, in-depth analysis, integrated workflow and ROI. It can serve as a powerful tool in decreasing FWA losses, increasing recoveries, developing provider educational programs, and optimizing operational efficiencies.

  • STARSSentinel® - Fraud and Abuse Lead Generation: Spot potential FWA automatically by identifying the most suspicious providers and members.
  • STARSInformant® - In-depth Investigative Analytics: Perform ad-hoc data exploration to fully support the investigation process.
  • STARSCommander® - Comprehensive Case Management: Manage workload/caseload throughout the lifecycle with advanced workflow features and reporting capabilities.
  • STARSInterceptor® - Pre-pay Protection: Stop payments before a check is mailed using predictive modeling and rule violations.

Expand the Reach of Your Special Investigations Unit with Outsourcing Solutions

With stretched budgets and too few qualified technical resources, today's healthcare executives can face a number of challenges in meeting critical objectives. General Dynamics IT can help you address these gaps with a high-performance infrastructure of people, processes and technology. We can help you augment your fraud, waste and abuse detection and investigation activities through STARSServices®, our highly experienced Special Investigations Unit team.

1. National Health Care Anti-fraud Association, 2009. http://www.nhcaa.org

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To learn firsthand how General Dynamics IT can help improve your efforts to fight Fraud, Waste and Abuse, click on Get a Free Demo.